Last month APA praised Reps. Benjamin Cardin (D-Md.) and Jim Ramstad
(R-Minn.) for co-sponsoring legislation that would reverse the exclusion of
benzodiazepine medications from reimbursement under the new Medicare Part D
"Your legislation is timely and most welcome, and the members of
APA—and most importantly their patients—are deeply grateful for
your leadership," wrote APA President Steven Sharfstein, M.D., in
letters to Cardin and Ramstad. "We look forward to working with both
co-sponsors on quick enactment of this most important bill."
Nicholas Meyers, director APA's Department of Government Relations, told
Psychiatric News, "We intend to do everything we can to
highlight the importance of passing the bill as a remedy to a provision in
Part D law that makes no sense from a health-policy perspective, and we
commend Reps. Cardin and Ramstad for their legislation."
The Medicare Modernization Act of 2003 (MMA) contained language that
required that benzodiazepines be excluded from coverage by the new drug
benefit, which begins January 1, 2006 (Psychiatric News, February 4).
Benzodiazepines are one of nine categories of medications excluded from the
list of medications that prescription drug plans will be required to cover
under the Part D benefit.
The blanket exclusion of benzodiazepines under the MMA could lead to
serious negative consequences for the physical and mental health of millions
of individuals to be covered by the new benefit. The exclusion could be
particularly troubling for the estimated 1.7 million dual-eligible patients
who have been prescribed benzodiazepines as a covered benefit under Medicaid.
If coverage ceases on January 1, 2006, these patients, who have been covered
by both Medicare and Medicaid, are unlikely to be able to afford to pay for
the medications out of pocket—even though the majority of
benzodiazepines are available as generics.
Abruptly ceasing benzodiazepines, particularly for those patients who have
been taking them for an extended period, can lead to a potentially severe
withdrawal syndrome, including seizures. Patients would need to be slowly
tapered off of benzodiazepines and switched to something else— a process
that often takes months.
Psychiatrist Stevan Gressitt, M.D., founder of the Maine Benzodiazepine
Study Group, told Psychiatric News during an interview for a previous
article, "The alternatives really are grim. If these patients don't have
access to benzodiazepines after January 2006, then they will most likely be
switched to something that is covered—an SSRI or an atypical
antipsychotic. Neither one of those would be my first choice for an elderly or
disabled patient with multiple medical problems who is probably taking several
The Centers for Medicare and Medicaid Services (CMS) earlier this year
issued guidelines that clarified that Medicare drug plans could cover
benzodiazepines as part of a supplemental coverage option but not under core
Part D benefits.
In addition, CMS said, states could continue to cover the drugs under
Medicaid. However, both options would require states to develop and implement
legislative authority and administrative procedures to allow the alternative
coverage and would have to fund the coverage out of state monies, not Medicare
Part D funds.
APA, in a press release on the introduction of the Cardin/Ramstad bill,
acknowledged these options, saying, "While [they are] helpful, these
options nonetheless create administrative problems and represent, at best, an
The bill introduced by Cardin and Ramstad (HR 3151) would remove only the
exclusion of benzodiazepines, not any of the other classes of excluded
The bill further calls on the secretary of Health and Human Services to
contract with "Medicare quality improvement organizations" for the
development of "appropriate educational guidelines for physicians
regarding the prescribing of benzodiazepines."
APA is assisting in the effort to find sponsors for an identical bill in
the Senate, Meyers said.
The text of HR 3151 can be accessed at<http://thomas.loc.gov/>
by searching on the bill number. APA's press release is posted at<www.psych.org/news_room/press_releases/05-41CardinRamstad07012005.pdf>.▪